FOAMcast - Emergency Medicine Core Content

We bring you highlights from ACEP2016 in Las Vegas.


Today we focus on the care of the transgender patient and some pearls on caring appropriately for our diverse patients.

We also cover active shooters and lawsuit pearls

 

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_ACEP16_Transgender.mp3
Category:general -- posted at: 6:27am EST

We cover an incredible ophthalmology resource, OphthoBook.com, by Dr. Tim Roots.  This resource has a free book and excellent free video lectures.  Specifically, we detail a hilarious video on eye exam tricks, especially targeting individuals who "can't see."

We previously reviewed eye trauma in this podcast. In this episode, we review ophthalmology basics using Tintinalli’s Emergency Medicine (8e), Chapter 241

Visit FOAMcast.org for more and Rosh Review questions. Thanks for listening! 

Jeremy Faust + Lauren Westafer

Direct download: nks..mp3
Category:general -- posted at: 5:30pm EST

The Free Open Access Medical Education (FOAM) 

We cover a post from Dr. Josh Farkas on PULMcrit on lithium toxicity. The key message from the post is: a single serum lithium level doesn't necessitate dialysis, despite a recommendation from the EXTRIP working group  to initiate dialysis in patients with a lithium level > 5 mEq/L [1].  Dr. Farkas advocates for aggressive management in asymptomatic patients with chronic lithium toxicity and patients without impaired renal function.

Core Content

We review rhabdomyolysis using Rosen's Emergency Medicine (8e)  Chapter 160 and Tintinalli's Emergency Medicine (8e), Chapter 181.

 

Show notes at FOAMcast.org

Thanks for listening!

Jeremy Faust & Lauren Westafer

Direct download: foamcast_57_lithium_and_rhabdo.mp3
Category:general -- posted at: 3:33pm EST

We review a FOAM post by Dr. Matthew MacPartlin on Rollcage Medic on flying after a pneumothorax.

Then we delve into a core content review of altitude sickness, high altitude pulmonary edema, high altitude cerebral edema, and altitude related problems using Tintinalli and Rosen's Emergency Medicine as a guide.

Thanks for listening!
-Jeremy Faust & Lauren Westafer

Direct download: foamcast_56_Aviation_and_Altitudes_.mp3
Category:general -- posted at: 3:35am EST

We cover several excellent post on rashes, including:

Next, we dive into core content on platelet problems including problems caused by drugs, immune thrombocytopenic purpura (ITP/idiopathic thrombocytopenic purpura) and thrombotic thrombocytopenic purpura (TTP) using Tintinalli Chapter 233 (8th ed) and Rosen's Chapter 122 (7th ed) as a guide.

 

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: Foamcast_55_Purpura_Show_.mp3
Category:general -- posted at: 6:12am EST

We cover ultrasound guided pericardiocentesis using the posts from EMin5, CoreEM, and the Ultrasound Podcast.

Then, we delve into core content on the pericardium using Rosen’s (8th ed) Chapter 82 and Tintinalli (8th ed) Chapter 55 covering pericardial effusions, pericarditis, and myocarditis.

 

Thanks for listening!

Jeremy Faust & Lauren Westafer

Direct download: foamcast_54_pericardiocentesis.mp3
Category:general -- posted at: 7:28am EST

We cover a post by Dr. Rory Spiegel, EMNerd: The Case of Differing Perspectives, on the results of the ATACH-2 trial on blood pressure control in intracranial hemorrhage (ICH). This study sought to determine the safety and efficacy of the

Population: adults (>18 y/o) with ICH on CT scan, GCS ≥ 5 and <4.5 hours since symptom onset (changed mid-study)

Intervention: Reduce and maintain the hourly minimum systolic blood pressure in the range of 110 to 139 mm Hg throughout the period of 24 hours after randomization ("intensive treatment"). Preferred agents for blood pressure control in order of preference were 1. nicardipine 2. labetalol (diltiazem or urapidil if not available)

  • Mean minimum in hours 0-2: 128.9±16 mm Hg

Control: Reduce and maintain the hourly minimum systolic blood pressure in the range of 140 to 179 mm Hg throughout the period of 24 hours after randomization.

  • Mean minimum in hours 0-2: 141.1±14.8 mm Hg

Outcome: The primary outcome was the proportion of patients who had moderately severe or severe disability (modified Rankin scale score (mRS) 4-5) or those who had died (mRS 6; hereafter referred to as “death or disability”) at 3 months.

  • death or disability: Intensive treatment = 186 participants (38.7%) vs Standard treatment = 181 (37.7%)

We also discuss the history of blood pressure control in ICH and the pendulum swing on this in recent years, using an episode of the Skeptic's Guide to Emergency Medicine, Episode 73. This episode covers the Interact-2 trial.

Core Content

We delve into core content on ICH using Rosen’s (8th ed) Chapter  and Chapter in Tintinalli (8th ed).

We also discuss the PATCH trial with regard to ICH management in patients on antiplatelet agents, discussing a REBELEM post on this trial.

 

 

Direct download: FOAMcast_53_ICH.mp3
Category:general -- posted at: 8:06am EST

Just in time for the new interns, we answer the most common question asked of us - our favorite resources to use on shift.

Free Open Access Medical Education (FOAM) exists in forms that are suitable for self-study or function as resources and those that are easy to use resources to consult on shift, Just In Time (JIT) Resources. We review our favorite FOAM JIT resources.

Direct download: FOAMcastini_July_1_Just_in_time_FOAM.mp3
Category:general -- posted at: 11:35am EST

We cover a Scancrit post on the Back Up Head Elevated (BUHE) intubation position.  This post details a multicenter retrospective observational study by Khandelwal et al in Anesthesia & Analgesia.  Intubating with the head elevated (ear to sternal notch) and the back of the bed up reduces complications.

We delve into core content on the esophagus using Rosen’s (8th ed) Chapter 71 and Chapter 77 in Tintinalli (8th ed). We discuss dysphagia, food impaction, and esophagitis.


Thanks for listening!

JEremy Faust and Lauren WEstafer

Direct download: Foamcast_52_Back_up_head_elevated_intubation_-_6-25-16_5.17_PM.mp3
Category:general -- posted at: 8:56am EST

ITUNES OR LISTEN HERE

We cover pearls from smaccDUB (Social Media and Critical Care Conference in Dublin, Ireland), Day 3. We are here thanks to the Rosh Review.

Dr. Scott Weingart - "Post-Intubation Sedation"

  • Analgesia first. Try a hydromorphone 1mg push while you're waiting for the fentanyl drip. The endotracheal tube is uncomfortable.
  • Minimize sedation. There's this principle: eCASH: early Comfort using Analgesia, minimal Sedatives and maximal Humane care [1]. 
  • Sedation: go for dexmedetomidine if you have it (but it's expensive) or propofol. This is supported by the Society of Critical Care Medicine (SCCM) Pain, Agitation, and Delirium guidelines [2].
  • Be careful with rocuronium.  The long duration of rocuronium means that you can't assess for pain or discomfort so you must be responsible and get these

Dr. David Carr - "The Aorta Will #!&?% You Up"

Screen Shot 2016-06-16 at 6.57.56 PM

Dr. Kathleen Thomas - "Oh Sh**! They’re bombing the hospital!"

We should not need a website entitled STOPBOMBINGHOSPITALS.ORG but, unfortunately, over the past 4 years, 400 hospitals have been bombed. This passionate, wrenching talk is a "must see" and "must listen" when the free talks are released on the SMACC podcast over the course of the next year.

ive use in the emergency department. Emergency medicine journal : EMJ. 30(11):893-5. 2013. [pubmed]

  1. Imamura H, Sekiguchi Y, Iwashita T et al. Painless Acute Aortic Dissection. Circ J. 75(1):59-66. 2011. [article]
  2. Diercks DB, et al. Clinical policy: critical issues in the evaluation and management of adult patients with suspected acute nontraumatic thoracic aortic dissection. Ann Emerg Med. 2015 Jan;65(1):32-42.e12. PMID: 25529153.
  3. Hagan PG, Nienaber CA, Isselbacher EM. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 283(7):897-903. 2000. [pubmed]
Direct download: Foamcastini_smaccdub_day_3_aorta_and_pain.mp3
Category:general -- posted at: 2:01pm EST